Intro to Urinary Tract Infections Flashcards
What are the different parts to the upper urinary tract?
Kidneys
• Parenchyma
• Pelvicalyceal system
Ureters
• Pelvic-ureteric junction
• Ureter
• Vesico-ureteric junction
What are the different parts to the lower urinary tract?
Bladder Bladder outflow tract • Bladder neck (intrinsic urethral sphincter) • Prostate • External urethral sphincter/pelvic floor • Urethra • Urethral meatus • Foreskin
What are different natures of renal diseases?
- Infection
- Inflammation
- Iatrogenic
- Neoplasia
- Trauma
- Vascular
- Hereditary
Give an examples of renal infection
Pyelonephritis
Give an examples of renal inflammation
Glomerulonephritis, tubulointerstitial nephritis
Give an examples of iatrogenic renal disease
Nephrotoxicity, PCNL
Give an examples of renal Neoplasia
Renal tumours, collecting system tumours
Give an examples of renal trauma
Blunt trauma
Give an examples of vascular renal disease
Atherosclerosis, hypertension, Diabetes
Give an examples of hereditary renal disease
Polycystic kidney disease, nephrotic syndrome
What is the typical presentation of renal disease?
- Pain
- Pyrexia
- Haematuria
- Proteinuria
- Pyuria (puss in urine)
- Mass on palpation
- Renal failure
What is the definition of proteinuria?
Urinary protein excretion >150mg/day
How many types of haematuria are there?
Two;
• Microscopic - only seen under a microscope
• Gross (or macroscopic)
Define microscopic haematuria
Found by urinalysis or urine dipstick; chronic or persistent if 5 or > RBCs per high-power field
Define oliguria
Urine output <0.5ml/kg/hour (low)
Define Anuria
- Absolute anuria - No urine output
* Relative anuria - <100ml/24 hours
Define polyuria
Urine output >3L/24 hours (high)
Define nocturia
Waking up at night ≥1 occasion to micturate
Define nocturnal polyuria
Nocturnal urine output > 1/3 of total urine output in 24 hours
Name common symptoms of UTIs
- Dysuria (pain)
- Frequency of urination
- Suprapubic tenderness
- Urgency
- Polyuria
- Haematuria
What are the five stages in acute kidney injury?
- Risk
- Injury
- Failure
- Loss
- End-stage kidney disease
Define the 1. Risk stage of acute kidney injury
- Increase in serum creatinine level (x1.5)
- Decrease in GFR by 25%
- UO < 0.5 mL/kg/h for 6hrs
Define the 2. Injury stage of acute kidney injury
- Increase in serum creatinine level (x2)
- Decrease in GFR by 50%
- UO < 0.5mL/kg/h for 12hrs
Define the 3. Failure stage of acute kidney injury
- Increase in serum creatinine (x3)
- Decrease in GFR by 75%
- UO < 0.3mL/kg/h for 24hrs, or anuria for 12hrs
Define the 4. Loss stage of acute kidney injury
- Persistent acute renal failure
* Complete loss of kidney function > 4 weeks
Define the 5. End-stage kidney disease stage of acute kidney injury
Complete loss of kidney function > 3 months
What are the six functions of the kidney?
- Body fluid homeostasis
- Electrolyte homeostasis
- Acid-base homeostasis (excrete H and generate HCO3)
- Regulation of vascular tone
- Excretory (urea, drugs etc)
- Endocrine functions
What are the endocrine functions of the kidneys?
- Erythropoeitin
- Vit D metabolism
- Renin
What are the symptoms and signs of chronic renal failure?
- Asymptomatic (found via blood and urine testing)
- Tiredness
- Anaemia
- Oedema
- High blood pressure
- Bone pain due to renal bone disease
In advanced Renal failure: • Pruiritus • Nausea/vomiting • Dyspnoea • Pericarditis • Neuropathy • Coma
Give an example of iatrogenic/trauma ureteric disease
Inadvertently cut or tied during hysterectomy or colon resection
Give an example of ureteric neoplasia
- Transitional cell cancer (TCC) of ureter
- TCC of bladder obstructing VUJ
- Prostate cancer obstructing VUJ
- Pelvic malignancy
- Pelvic or para-aortic lymphadenopathy
Give an example of hereditary ureteric disease
- Pelvic-ureteric junction (PUJ) obstruction
* Vesico-ureteric junction (VUJ) reflux
Give an examples of causes of ureteric obstruction
- Intra-luminal (stone, blood blot)
- Intra-mural (scar tissue, TCC)
- Exrta-luminal (pelvic mass, lymph nodes)
What is the typical presentation of ureteric disease?
- Pain (eg. renal colic)
- Pyrexia
- Haematuria
- Palpable mass (ie. hydronephrosis)
- Renal failure (only if bilateral obstruction or single functioning kidney)
What is the typical presentation of bladder diseases?
- Pain (suprapubic)
- Pyrexia
- Haematuria
- Lower urinary tract symptoms (LUTS)
- Recurrent UTIs
- Chronic urinary retention (due to bladder underactivity)
- Urinary leak from vagina (i.e. vesico-vaginal fistula)
- Pneumaturia (i.e. colo-vesical fistula)
What are the lower urinary tract symptoms of bladder diseases?
- Storage LUTS (i.e. frequency, nocturia, urgency, urge incontinence)
- Voiding LUTS (i.e. poor flow, intermittency, terminal dribbling) – due to underactive bladder
- Incontinence (stress, urge, mixed, overflow, neurogenic, dribbling, etc.)
Give examples of the different nature of bladder diseases and their causes
Infection - cystitis
Inflammation - interstitial cystitis, colonic diverticulitis resulting in colo-vesical fistula
Iatrogenic/Trauma - bladder rupture, bladder injury from hysterectomy (resulting in vesico-vaginal fistula)
Neoplasia - TCC of bladder, squamous cell carcinoma of bladder
Idiopathic - overactive bladder syndrome
Degenerative - chronic urinary retention
Neurological - neurogenic bladder dysfunction
Describe the control of micturition
1) Cortical centre (bladder sensation and conscious inhibition of micturition)
2) Pons (micturition centre)
3) Sacral segments (S2-S4) (micturition reflex):
• Relaxation of internal urethral sphincter (autonomic - sympathetic)
• Relaxation of external urethral sphincter (somatic)
• Contraction of detrusor muscle (autonomic – parasympathetic)
What are possible causes of LUTS?
• Bladder pathology (OAB, UTI, interstitial cystitis, bladder cancer)
• Bladder outflow obstruction
• Pelvic floor dysfunction
• Neurological causes (i.e. neurogenic bladder dysfunction):
- Supra-pontine lesions (i.e. stroke, alzheimers, parkinsons)
- Infra-pontine supra-sacral lesions (i.e. spinal cord injury, disc prolapse, spina bifida)
- Infra-sacral (i.e. MS, diabetes, cauda equina compression)
• Systemic disorders (i.e. chronic renal failure, cardiac failure, diabetes mellitus, diabetes insipidus)
What are the two stages in the micturition cycle?
- Storage (or filling) phase
2. Voiding phase
What are the different natures of bladder outflow tract diseases?
Infection/Inflammation - prostatitis, balanitis
Iatrogenic/Trauma - pelvic floor damage after traumatic vaginal delivery or hysterectomy, urethral injury from catheterisation or pelvic fracture
Neoplasia - prostate cancer, penile cancer
Idiopathic - chronic pelvic pain syndrome
Obstruction: • Primary bladder neck obstruction • Benign prostatic enlargement (BPE) causing obstruction • Urethral stricture • Meatal stenosis • Phimosis
What is the presentation on bladder outflow tract disease?
• Pain (suprapubic or perineal) • Pyrexia • Haematuria • Lower urinary tract symptoms (LUTS) - Voiding LUTS (i.e. hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying) due to Bladder Outflow Obstruction (BOO) - Overflow incontinence (high-pressure chronic urinary retention) - Stress urinary incontinence • Recurrent UTIs • Acute urinary retention • Chronic urinary retention
What is acute urinary retention?
Defined as painful inability to void with a palpable and percussible bladder
• 500ml to 1L
What are causes for acute urinary retention?
Main risk is Benign Prostatic Obstruction (BPO) but can also occur independently of BPO (i.e. UTI, urethral stricture, alcohol excess, post-op)
For those with BPO, usually triggered by unrelated event (i.e. constipation, alcohol excess, post-op)
What is the treatment of acute urinary retention?
- Immediate treatment is catheterisation
* Also treat underlying cause
